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In this article the authors tried to generalize and summarise the worldwide experience of treatment of serious category of the victims injured patients with severe combined abdomen trauma.

The article reports a clinical case of surgical therapy of a patient with simultaneous chest and abdomen trauma and carcinoid of the appendix.

WOS: 000328083700012, PubMed: 26815549, Purpose Abdominal trauma is the third most common cause of all trauma-related deaths in children. Liver injury is the second most common, but the most fatal injury associated with abdomen trauma. Because the liver enzymes have high sensitivity and specificity, the use of tomography has been discussed for accurate diagnosis of liver injury. Methods Our study was based on retrospective analyses of hemodynamically stabil patients under the age of 18 who were admitted to the emergency department with blunt abdominal trauma. Results Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly higher as a result of liver injury. In the patients whose AST and ALT levels were lower than 40 IU/L, no liver injury was observed in the contrast-enhanced computed tomography (CT). No liver injury was detected in the patients with AST levels lower than 100 IU/L. Liver injury was detected with contrast-enhanced CT in only one patient whose ALT level was lower than 100 IU/L, but ultrasonography initially detected liver injury in this patient. Conclusions According to our findings, abdominal CT may not be necessary to detect liver injury if the patient has ALT and AST levels below 100 IU/L with a negative abdominal USG at admission and during follow-up.

Benjaminas Siaurusaitis, Kestutis Trainavicius, Gintarė Breivienė, Andrius Cekuolis, Arūnas Strumila Vilniaus universiteto Vaikų ligoninė ir Vaikų ligų klinika Santariskių g. 7, LT-08406 Vilnius El pastas: gintas.posiunas@rvuvl.vu.lt Įvadas / tikslas Dauguma vaikų uždarų pilvo traumų pastaraisiais metais isgydoma konservatyviai. Darbo tikslas – apžvelgti sių traumų gydymo taktiką per 25 metus ir jo rezultatus. Ligoniai ir metodai Retrospektyviai analizuota 1979–2003 metais gydytų 1139 vaikų uždarų pilvo traumų priežastys, sužalojimų klinikiniai ir tyrimų duomenys, gydymo metodai ir rezultatai. Rezultatai Vaikų uždaros pilvo traumos dažniausiai įvyksta dėl buitinių traumų ir autoįvykių. Daugėja smurtinių traumų. Dažniausiai sužalojama blužnis (174 ligoniai, 15,3% visų traumų). Kepenų sužalojimai nustatyti 42 ligoniams (3,7%). Dėl tikslesnės diagnostikos per pastaruosius 5 metus sių pažeidimų gydymo taktika tapo konservatyvesnė: neoperuojant isgydyti 39 is 47 blužnies traumą patyrusių vaikų (83,0%) ir 10 is 12 kepenų traumą patyrusių vaikų (83,3%). Vaikų ertminių pilvo organų sužalojimai reti: 36 ligoniai (3,2%). Visi kasos, dvylikapirstės žarnos traumas patyre ligoniai buvo operuoti. Jie pasveiko. 865 ligoniams (75,9%) diagnozuotas tik pilvo sumusimas. Mirė 3 ligoniai (0,3%). Isvados Nauji siuolaikiniai tyrimo metodai – echoskopija, kompiuterinė tomografija – labai pakeitė vaikų uždarų pilvo traumų gydymo taktiką. Dėl tikslesnės diagnostikos daugumą blužnies, kepenų, kasos sužalojimų galima isgydyti konservatyviai. Operuojama besitesiant ar atsinaujinus kraujavimui ir esant nestabiliai hemodinamikai. Reiksminiai žodžiai: vaikų uždaros pilvo traumos, pilvo organų sužalojimai, diagnostika, chirurginio gydymo taktika Blunt abdomen injury in children: diagnosis and treatment Benjaminas Siaurusaitis, Kestutis Trainavicius, Gintarė Breivienė, Andrius Cekuolis, Arūnas Strumila Background / objective The large majority of children with blunt abdomen trauma are treated non-operatively. The aim of our study was to analyze the tactics of treatment of blunt abdomen trauma and the results of 25 years. Patients and methods The retrospective study of 1139 patients treated in our clinic between 1979 and 2003 has been undertaken. Causes of trauma, clinical and diagnostic data, methods of treatment and results were analyzed. Results The most common causes of injuries were conditions of life and motor vehicle accidents, but violent traumas were also frequent. Spleen injury was the most frequent blunt trauma (174 patients, 15.3%). Hepatic trauma was diagnosed in 42 patients (3.7%). The diagnosis was made clinically and confirmed by sonography. The background for non-operative treatment was the precise diagnostics including CT-scan: in the last 5 years 83% of spleen (39 patients) and liver (10 patients) injuries were treated non-operatively. All 36 patients (3.2%) with intestinal injuries were operated on. Injuries of the retroperitoneal organs (duodenum, pancreas) were rare. The diagnosis was confirmed by CT. All patients were operated on and recovered. The large majority of patients (865 patients, 75.9%) underwent only abdomen contusion. There were 3 deaths (0.3%). Conclusions New diagnostic modalities, sonography and CT-scan, changed the management of patients with blunt abdominal trauma. Most patients with liver and spleen blunt injuries are treated non-operatively. Operative treatment is indicated if there are signs of continuing bleeding and patients are hemodinamically unstable. Keywords: blunt abdomen injury in children, intraabdominal injuries, diagnosis, tactics of surgical treatment

Excellent results can be obtained with conservative therapy of intramural duodenal hematomas, and thus the radiologist plays a crucial role in their management and followup. Six children in in whom intramural duodenal hematoma was diagnosed, based on clinical, laboratory, and radiographic findings, were managed conservatively. Treatment consisted of restricted oral intake, intravenous infusion of fluids and electrolytes, and nasogastric suction when indicated. The satisfactory response of these patients to nonoperative therapy was demonstrated on serial upper gastrointestinal studies and by regression of clinical signs and symptoms.

Flexible fiberoptic endoscopes are being increasingly used for direct visualization and biopsy of lesions of the gastrointestinal tract. The spectrum of gastrointestinal complications associated with fiber-optic esophagoscopy, gastroscopy, and colonoscopy is reviewed. Radiologic recognition and evaluation of these iatrogenic incidents is of critical importance.

A gunshot wound to the ureter was diagnosed anigiographically. Such injuries are not common; however, they are frequent enough and the consequences of delayed diagnosis and secondary repair are serious enough that ureteric injury should be considered in all cases of abdominal trauma.